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CAM surgical template system for osseous genioplasty
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Oral Presentation
organ was able to restore the facial contour and functionality. The presented work represents one of many cases in which advanced clinical care is provided based on clinical indications and functional needs in a rapid and accurate method that, in our opinion, is the future of craniofacial treatment. http://dx.doi.org/10.1016/j.ijom.2015.08.657 A retrospective analysis of osseo-integrated implants placed into vascularised free-flaps of the head and neck – a multicentre analysis M. Burgess 1 , M. Leung 2,∗ , A. Chellapah 3 , A. Crombie 4 , J. Clark 5 , M. Batstone 1 1
Royal Brisbane Hospital, Brisbane, Australia University of Sydney, Sydney, Australia 3 University of Queensland, Brisbane, Australia 4 Princess Alexandria Hospital, Brisbane, Australia 5 Royal Prince Alfred Hospital, Sydney, Australia 2
Background: Significant morbidity is experienced after head and neck lesion ablation.1 The use of implants for reconstruction in head and neck cancer patients has shown to significantly improve the quality of life for these patients.1 Outcome data has been variable with success rates ranging from 99% to 70%.2 There is minimal data for implants placed into scapula free flaps. Methods: A retrospective audit of patient records was performed. Inclusion criteria were patients who received vascularised free-flaps at two Australian Head and Neck Units and received oral reconstructive implants. Statistical analysis was performed including Kaplan–Meier survival curves and regression modelling. Findings: 62 patients were included for analysis. This included 232 implants with 206 placed into vascularised free-flaps. The overall success rate for the implants placed was 92.77%. Implants placed into fibula free-flaps showed a significant failure rate when compared with iliac crest and scapula flaps (P < 0.0001). 20% of implants placed immediately into flaps failed. Conclusions: Implant failures in this cohort have comparative success rates to those in healthy subjects. The significant finding being increased failure rates in fibula flaps as compared to iliac crest or scapula flaps.
References Allison, P. J., Locker, D., & Feine, J. S. (1999). The relationship between dental status and health-related quality of life in upper aerodigestive tract cancer patients. Oral Oncol, 35(2), 138–143. Ali, A., et al. (1997). Implant rehabilitation of irradiated jaws: a preliminary report. Int J Oral Maxillofac Implants, 12(4), 523–526.
http://dx.doi.org/10.1016/j.ijom.2015.08.658 Guided-bone regeneration as an adjunctive procedure of lower third molar coronectomy Y.Y. Leung Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Background: Root migration after lower third molar coronectomy may result in root exposure in long term. Guided bone
regeneration (GBR) as an adjunctive procedure in lower third molar coronectomy may reduce this complication. Objectives: To investigate root migration rate and other surgical morbidities after lower third molar coronectomy with or without adjunctive GBR. Methods: A split-mouth randomized clinical trial of patients with bilateral lower third molars that require coronectomy was performed. One third molar in each patient was randomized to receive coronectomy with GBR and the other side to receive coronectomy alone. The patients were reviewed at post-operative 2 weeks, 3, 6 and 12 months. Root migration rate and surgical morbidities including pain, infection, dry socket, wound dehiscence, neurosensory deficit and loss of attachment of the adjacent second molar were assessed. Findings: 20 patients (8 males) with mean age 28.6 years (S.D. 7.5 years) were recruited. Root migration after coronectomy with GBR at post-operative 2 weeks, 3 months, 6 months and 12 months were 0.18 mm (S.D. 0.36 mm), 0.60 mm (S.D. 0.72 mm), 0.65 mm (S.D. 0.88 mm) and 0.67 mm (S.D. 0.85 mm), respectively. The migration rate of coronectomy with adjunctive GBR was significantly less than the group with coronectomy alone from 3 months onwards. No root exposure was found in both groups. No statistical difference was found between the two groups in terms of all the other surgical morbidities. Conclusions: Coronectomy with adjunctive GBR in lower third molar can reduce the root migration rate and carries similar morbidities when compared to coronectomy alone. http://dx.doi.org/10.1016/j.ijom.2015.08.659 A new design of CAD/CAM surgical template system for osseous genioplasty B. Li 1,2 1 Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China 2 Shanghai Key Laboratory of Stomatology, Shanghai, China
Background: Because of the challenge that the chin deformity may exist in all three dimensions, it is critical to precisely transfer the plan to the patient at the time of the surgery. Objectives: The purpose of this study is to develop and validate a new chin template system for genioplasty, which can guide both the osteotomy and the chin repositioning. Methods: Monoblock genioplasty and 2-piece narrowing genioplasty were scheduled for thirty patients with chin deformities enrolled in this study. Surgeries were planned with the computer-aided surgical simulation (CASS) planning method. Chin template were designed in computer and fabricated using three-dimensional printing technique. The chin template system included a cutting guide and a repositioning guide. These guides were also designed to avoid mental foramen area and inferior alveolar nerve loops during the osteotomy for nerve protection. After surgery, outcome evaluation was completed by first superimposing the postoperative computed tomography (CT) model onto the planned model, and then measuring the differences between planned and actual outcomes. Findings and conclusions: All surgeries were successfully completed by our chin templates system. No inferior alveolar nerve damage was found in this study. With the use of chin templates, the largest linear root mean square deviation (RMSD) between the planned and the postoperative chin segments was 0.6 mm and the largest angular RMSD was 3.5◦ . The results
Oral Presentation showed that the chin template system provide a reliable method for transfer of for osseous genioplasty planning. http://dx.doi.org/10.1016/j.ijom.2015.08.660 Large full-thickness labial defects repaired by free flaps C. Li ∗ , Y. Men, L. Li, B. Han, Y. Li West China Hospital of Stomatology, Sichuan University, Chengdu, China Background: Reparation of labial large defects is a big challenge of oral and maxillofacial surgeon nowadays. Objectives: To investigate the effect of free flaps in the reconstruction of large full-thickness labial defects. Methods: Patients with large full-thickness defects of the lip in West China Hospital of Stomatology, Sichuan University between 2010 and 2014 were retrospectively reviewed. The demographic characteristics, causes of defects, types of flaps and survival, etc. were recorded. Findings and conclusions: A total of 15 patients received free flap reconstruction for large full-thickness labial defects with ages between 39 and 72 and there were 11 males and 4 females. Causes of the defects were labial squamous cell carcinoma (6), buccal squamous cell carcinoma involving the lip (4), labial malignant melanoma (2), gingival malignant melanoma involving the lip (1), labial epithelial myoepithelial carcinoma (1) and labial skin cancer (1). 15 radial forearm flaps were used in 14 patients (with one flap was necrosis and repaired by contralateral forearm flap), and 1 anterolateral thigh flap for 1 patient. The follow-up period was between 6 and 42 months, with one died with disease recurrence and 1 had recurrence but salvaged. All patients had intact oral function and good aesthetic results. Large full-thickness labial defects require free-flap reconstruction. And this reconstruction had a good practicability and aesthetic results. http://dx.doi.org/10.1016/j.ijom.2015.08.661 Comprehensive consideration and design for treatment of osteochondroma in the mandibular condyle with secondary dentofacial deformities in adults J. Li ∗ , J. Hu, E. Luo, S. Zhu, B. Ye, Y. Li West China College of Stomatology, Sichuan University, Chengdu, China Purpose: Osteochondroma is a benign tumor, which is usually rare in the mandibular region, especially around the condyle. The secondary progressive malocclusion and facial asymmetry are common physical signs in most cases. The traditional surgical treatment for osteochondroma of the mandibular condyle has been condylectomy with or without condylar reconstruction. We opine that in addition to removal of the tumor, attention should also be paid towards restoring the joint function, improving facial appearance and correcting secondary malocclusion. Patients and methods: From January 2000 to March 2013, 27 patients (17 female and 10 male) who were diagnosed with unilateral mandibular condyle osteochondroma underwent condylectomy and condylar reconstruction using pedicled posterior mandibular border by vertical ramus osteotomy, and simultaneous correction of the secondary dentofacial deformities using comprehensive orthognathic and facial contouring procedures, followed by orthodontic treatment. Occlusion and temporomandibular joint pain and function including maximal
e99
mouth opening and maximum protrusion were recorded preoperatively and postoperatively. Results: The patients were followed-up for an average of 13 months (range 24–48 months). The outcomes and the feedback information of patients showed improved joint function with no cases of the tumor recurrence. The secondary dentofacial deformities were corrected significantly, and satisfactory occlusion was achieved with orthognathic and orthodontic treatment. Conclusion: Our data suggest that condylectomy and condylar reconstruction, with simultaneous correction of the secondary dentofacial deformities by use of comprehensive orthognathic might be a better approach to manage osteochondroma accompanied by dentofacial deformities. In addition to facial contouring procedures, orthodontic treatment should be considered postoperatively for better facial esthetics and occlusion. http://dx.doi.org/10.1016/j.ijom.2015.08.662 Personalized design and comprehensive consideration for the treatment of square face in Asian X. Li ∗ , J. Li ∗ , Y. Hsu, J. Hu, A. Khadka, T. Chen West China Hospital of Stomatology Sichuan University, Chengdu, China Background: In contrast to West, East Asian generally do not prefer facial features with prominent angle, because it gives them a fierce and masculine impression. Square facial shape is usually due to prominent mandibular angle and disharmonious proportion of facial contour. However, conventional surgeries that reduce mandibular width or soften posterior mandible but ignore midface width/prominence and configuration of chin will probably ultimately fail in pursuing harmonious facial profile and favorable surgical effect. Objectives: We want to investigate that whether attention should be paid to zygomatic projection in addition to square mandible from the frontal view; and gonial angle and mental region configuration from the lateral view so as to obtain slender oval face. Method: From 2010 to 2014, in a total of 36 patients, the authors had applied the combination of four operative techniques – L-shaped osteotomy zygomatic reduction, mandibular “V-line” ostectomy, Mandibular outer cortex splitting ostectomy, and sliding genioplasty – to reshape the square face. Findings and conclusions: We found that these methods made the square face look more harmonious. We concluded that once correction of the square face is sought, the surgeon should consider the facial contour as a whole and perform facial contouring surgery from middle 3rd to the lower 3rd of the face to achieve perfection. Pre or post-treatment
Oral Presentation
organ was able to restore the facial contour and functionality. The presented work represents one of many cases in which advanced clinical care is provided based on clinical indications and functional needs in a rapid and accurate method that, in our opinion, is the future of craniofacial treatment. http://dx.doi.org/10.1016/j.ijom.2015.08.657 A retrospective analysis of osseo-integrated implants placed into vascularised free-flaps of the head and neck – a multicentre analysis M. Burgess 1 , M. Leung 2,∗ , A. Chellapah 3 , A. Crombie 4 , J. Clark 5 , M. Batstone 1 1
Royal Brisbane Hospital, Brisbane, Australia University of Sydney, Sydney, Australia 3 University of Queensland, Brisbane, Australia 4 Princess Alexandria Hospital, Brisbane, Australia 5 Royal Prince Alfred Hospital, Sydney, Australia 2
Background: Significant morbidity is experienced after head and neck lesion ablation.1 The use of implants for reconstruction in head and neck cancer patients has shown to significantly improve the quality of life for these patients.1 Outcome data has been variable with success rates ranging from 99% to 70%.2 There is minimal data for implants placed into scapula free flaps. Methods: A retrospective audit of patient records was performed. Inclusion criteria were patients who received vascularised free-flaps at two Australian Head and Neck Units and received oral reconstructive implants. Statistical analysis was performed including Kaplan–Meier survival curves and regression modelling. Findings: 62 patients were included for analysis. This included 232 implants with 206 placed into vascularised free-flaps. The overall success rate for the implants placed was 92.77%. Implants placed into fibula free-flaps showed a significant failure rate when compared with iliac crest and scapula flaps (P < 0.0001). 20% of implants placed immediately into flaps failed. Conclusions: Implant failures in this cohort have comparative success rates to those in healthy subjects. The significant finding being increased failure rates in fibula flaps as compared to iliac crest or scapula flaps.
References Allison, P. J., Locker, D., & Feine, J. S. (1999). The relationship between dental status and health-related quality of life in upper aerodigestive tract cancer patients. Oral Oncol, 35(2), 138–143. Ali, A., et al. (1997). Implant rehabilitation of irradiated jaws: a preliminary report. Int J Oral Maxillofac Implants, 12(4), 523–526.
http://dx.doi.org/10.1016/j.ijom.2015.08.658 Guided-bone regeneration as an adjunctive procedure of lower third molar coronectomy Y.Y. Leung Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Background: Root migration after lower third molar coronectomy may result in root exposure in long term. Guided bone
regeneration (GBR) as an adjunctive procedure in lower third molar coronectomy may reduce this complication. Objectives: To investigate root migration rate and other surgical morbidities after lower third molar coronectomy with or without adjunctive GBR. Methods: A split-mouth randomized clinical trial of patients with bilateral lower third molars that require coronectomy was performed. One third molar in each patient was randomized to receive coronectomy with GBR and the other side to receive coronectomy alone. The patients were reviewed at post-operative 2 weeks, 3, 6 and 12 months. Root migration rate and surgical morbidities including pain, infection, dry socket, wound dehiscence, neurosensory deficit and loss of attachment of the adjacent second molar were assessed. Findings: 20 patients (8 males) with mean age 28.6 years (S.D. 7.5 years) were recruited. Root migration after coronectomy with GBR at post-operative 2 weeks, 3 months, 6 months and 12 months were 0.18 mm (S.D. 0.36 mm), 0.60 mm (S.D. 0.72 mm), 0.65 mm (S.D. 0.88 mm) and 0.67 mm (S.D. 0.85 mm), respectively. The migration rate of coronectomy with adjunctive GBR was significantly less than the group with coronectomy alone from 3 months onwards. No root exposure was found in both groups. No statistical difference was found between the two groups in terms of all the other surgical morbidities. Conclusions: Coronectomy with adjunctive GBR in lower third molar can reduce the root migration rate and carries similar morbidities when compared to coronectomy alone. http://dx.doi.org/10.1016/j.ijom.2015.08.659 A new design of CAD/CAM surgical template system for osseous genioplasty B. Li 1,2 1 Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China 2 Shanghai Key Laboratory of Stomatology, Shanghai, China
Background: Because of the challenge that the chin deformity may exist in all three dimensions, it is critical to precisely transfer the plan to the patient at the time of the surgery. Objectives: The purpose of this study is to develop and validate a new chin template system for genioplasty, which can guide both the osteotomy and the chin repositioning. Methods: Monoblock genioplasty and 2-piece narrowing genioplasty were scheduled for thirty patients with chin deformities enrolled in this study. Surgeries were planned with the computer-aided surgical simulation (CASS) planning method. Chin template were designed in computer and fabricated using three-dimensional printing technique. The chin template system included a cutting guide and a repositioning guide. These guides were also designed to avoid mental foramen area and inferior alveolar nerve loops during the osteotomy for nerve protection. After surgery, outcome evaluation was completed by first superimposing the postoperative computed tomography (CT) model onto the planned model, and then measuring the differences between planned and actual outcomes. Findings and conclusions: All surgeries were successfully completed by our chin templates system. No inferior alveolar nerve damage was found in this study. With the use of chin templates, the largest linear root mean square deviation (RMSD) between the planned and the postoperative chin segments was 0.6 mm and the largest angular RMSD was 3.5◦ . The results
Oral Presentation showed that the chin template system provide a reliable method for transfer of for osseous genioplasty planning. http://dx.doi.org/10.1016/j.ijom.2015.08.660 Large full-thickness labial defects repaired by free flaps C. Li ∗ , Y. Men, L. Li, B. Han, Y. Li West China Hospital of Stomatology, Sichuan University, Chengdu, China Background: Reparation of labial large defects is a big challenge of oral and maxillofacial surgeon nowadays. Objectives: To investigate the effect of free flaps in the reconstruction of large full-thickness labial defects. Methods: Patients with large full-thickness defects of the lip in West China Hospital of Stomatology, Sichuan University between 2010 and 2014 were retrospectively reviewed. The demographic characteristics, causes of defects, types of flaps and survival, etc. were recorded. Findings and conclusions: A total of 15 patients received free flap reconstruction for large full-thickness labial defects with ages between 39 and 72 and there were 11 males and 4 females. Causes of the defects were labial squamous cell carcinoma (6), buccal squamous cell carcinoma involving the lip (4), labial malignant melanoma (2), gingival malignant melanoma involving the lip (1), labial epithelial myoepithelial carcinoma (1) and labial skin cancer (1). 15 radial forearm flaps were used in 14 patients (with one flap was necrosis and repaired by contralateral forearm flap), and 1 anterolateral thigh flap for 1 patient. The follow-up period was between 6 and 42 months, with one died with disease recurrence and 1 had recurrence but salvaged. All patients had intact oral function and good aesthetic results. Large full-thickness labial defects require free-flap reconstruction. And this reconstruction had a good practicability and aesthetic results. http://dx.doi.org/10.1016/j.ijom.2015.08.661 Comprehensive consideration and design for treatment of osteochondroma in the mandibular condyle with secondary dentofacial deformities in adults J. Li ∗ , J. Hu, E. Luo, S. Zhu, B. Ye, Y. Li West China College of Stomatology, Sichuan University, Chengdu, China Purpose: Osteochondroma is a benign tumor, which is usually rare in the mandibular region, especially around the condyle. The secondary progressive malocclusion and facial asymmetry are common physical signs in most cases. The traditional surgical treatment for osteochondroma of the mandibular condyle has been condylectomy with or without condylar reconstruction. We opine that in addition to removal of the tumor, attention should also be paid towards restoring the joint function, improving facial appearance and correcting secondary malocclusion. Patients and methods: From January 2000 to March 2013, 27 patients (17 female and 10 male) who were diagnosed with unilateral mandibular condyle osteochondroma underwent condylectomy and condylar reconstruction using pedicled posterior mandibular border by vertical ramus osteotomy, and simultaneous correction of the secondary dentofacial deformities using comprehensive orthognathic and facial contouring procedures, followed by orthodontic treatment. Occlusion and temporomandibular joint pain and function including maximal
e99
mouth opening and maximum protrusion were recorded preoperatively and postoperatively. Results: The patients were followed-up for an average of 13 months (range 24–48 months). The outcomes and the feedback information of patients showed improved joint function with no cases of the tumor recurrence. The secondary dentofacial deformities were corrected significantly, and satisfactory occlusion was achieved with orthognathic and orthodontic treatment. Conclusion: Our data suggest that condylectomy and condylar reconstruction, with simultaneous correction of the secondary dentofacial deformities by use of comprehensive orthognathic might be a better approach to manage osteochondroma accompanied by dentofacial deformities. In addition to facial contouring procedures, orthodontic treatment should be considered postoperatively for better facial esthetics and occlusion. http://dx.doi.org/10.1016/j.ijom.2015.08.662 Personalized design and comprehensive consideration for the treatment of square face in Asian X. Li ∗ , J. Li ∗ , Y. Hsu, J. Hu, A. Khadka, T. Chen West China Hospital of Stomatology Sichuan University, Chengdu, China Background: In contrast to West, East Asian generally do not prefer facial features with prominent angle, because it gives them a fierce and masculine impression. Square facial shape is usually due to prominent mandibular angle and disharmonious proportion of facial contour. However, conventional surgeries that reduce mandibular width or soften posterior mandible but ignore midface width/prominence and configuration of chin will probably ultimately fail in pursuing harmonious facial profile and favorable surgical effect. Objectives: We want to investigate that whether attention should be paid to zygomatic projection in addition to square mandible from the frontal view; and gonial angle and mental region configuration from the lateral view so as to obtain slender oval face. Method: From 2010 to 2014, in a total of 36 patients, the authors had applied the combination of four operative techniques – L-shaped osteotomy zygomatic reduction, mandibular “V-line” ostectomy, Mandibular outer cortex splitting ostectomy, and sliding genioplasty – to reshape the square face. Findings and conclusions: We found that these methods made the square face look more harmonious. We concluded that once correction of the square face is sought, the surgeon should consider the facial contour as a whole and perform facial contouring surgery from middle 3rd to the lower 3rd of the face to achieve perfection. Pre or post-treatment